Monthly Archives: August 2015

Goal is outlined in ONC’s roadmap

August 14, 2015

Fewer than 20% of health care providers believe the Office of the National Coordinator for Health IT (ONC) can achieve nationwide interoperability in 10 years, according to a survey by document management company Scrypt.

The findings were part of poll of more than 700 providers on their opinions of interoperability and HIPAA guidelines.

Background on ONC’s goal

It outlines short- and long-term goals for the next 10 years, with 2017 set as the deadline by which “a majority of individuals and providers across the care continuum” should be able “to send, receive, find and use a common set of electronic clinical information.”

In addition, the document outlines 10 updated guiding principles for achieving nationwide interoperability over a 10-year period based on stakeholder feedback.

Survey findings

However, the new survey suggests that just 17% of providers are confident the health care industry will meet ONC’s 10-year interoperability goal.

Meanwhile, the survey also found that while 98% of respondents said their organizations have policies in place to keep staff updated about HIPAA compliance changes in their practice, staff or human error remains the largest concern among providers in terms of HIPAA breaches (Monegain, Healthcare IT News, 8/11; Slabodkin, Health Data Management, 8/12; Scrypt release, 8/11).

Hospitals are worried a new rule from the Federal Communications Commission that will allow unlicensed devices to use the same wireless band as patient monitors could cause dangerous interference with the medical systems.

The FCC will allow unlicensed devices developed in the future to communicate on the TV and 600 mhz bands, part of which is now used by wireless medical telemetry systems, which allows vital-sign sensors to communicate with patient monitors and nurse station monitors. The monitors have exclusively used the band’s Channel 37, which would now be available to new devices.

Providers are concerned that allowing other types of devices to operate in relatively close proximity to hospitals’ wireless systems may interfere with patient monitoring, “preventing doctors and nurses from receiving vital information,” said Rick Pollack, the American Hospital Association’s executive vice president for advocacy and public policy and the organization’s next president and CEO.

“We remain highly concerned that if the rules adopted today are left unchanged, patient safety could be compromised,” Pollack said in a statement. “We will continue to work with Congress, the FCC and device developers to seek a remedy that puts patients first.”

The FCC has established buffer zones around hospitals to prevent interference, and those areas can be extended at the request of the facility if they’re found to be inadequate. The size of the FCC’s hospital buffer is 380 meters, but the AHA is looking for a standard buffer of at least 3 kilometers around hospitals, said Erik Rasmussen, vice president for legislative affairs at the AHA.

“They’ve drawn those lines, that circle around the hospital … it’s too close,” Rasmussen said. “There could be a device outside but it could still block the signal outside the hospital.”

The AHA tested the FCC’s proposed zones with the help of healthcare experts at General Electric Co., a leading manufacturer of patient monitors, and found that devices could interfere with wireless medical telemetry even when they were operating outside of the FCC’s buffer zone.

In order to have a buffer zone at all, hospitals would need to register with a database that would then be provided to device manufacturers. But hospitals haven’t had to worry about this problem in the past, so they haven’t signed up for similar databases. There would need to be a push to get them to sign up, said Ken Fuchs, executive vice president for interoperability research and development at the not-for-profit Center for Medical Interoperability.

“These systems were designed basically to be the only players in town,” Fuchs said. “They weren’t designed with the consideration that there may be interfering systems in the vicinity.”

GE Healthcare said in a statement that it remains concerned that the buffer zones are not adequate, but commended the FCC for allowing protection to be extended in cases where it is insufficient.

“We look forward to continuing ongoing, productive discussions working toward a final technical resolution with unlicensed white space device advocates,” the company said in a statement. “We believe these discussions are the best way to come up with a sustainable, practical solution and the accompanying technical sharing rules that hospitals will rely on.”

But not all manufacturers will run into trouble. Welch Allyn decided to switch its patient monitor transmissions to WiFi in the late 1990s in response to market forces and in the belief that patient monitors would perform better on the more sophisticated band, said Steve Baker, a principal engineer at the Skaneateles Falls, N.Y.-based medical equipment company.

Baker wondered whether the Food and Drug Administration will ask manufacturers using Channel 37 to recertify their devices’ safety and effectiveness, given that they were designed during a time where they didn’t have to counter interference.

“It’s ironic (that Channel 37) was used to address patient safety and the current rule backtracks that,” Baker said.

It’s not clear what kind of devices the government is intending to make room for on the wireless band. The rule says only that Congress asked the commission to “accommodate growing demand for and encourage innovation in unlicensed use.”

But if the AHA decides not to appeal the decision, it may need to engage in negotiations with manufacturers interested in using the band and agree on ways to mitigate interference.

Google is one of the companies reportedly interested in developing devices for use on the frequency and has already been in talks with the AHA. Google did not respond to a request for comment.

Interoperability has become the holy grail of health IT. Though it is the universal goal, there is little consensus on how to get there. Even definitions of what interoperability is are varied, and removing business barriers for the sake of free flow of data between proprietary vendors and organizations sometimes seems to be more of a talking point than an action taken.

Thought leaders are vocal on the subject of interoperability. Here is what 15 of them had to say.

Dan Haley, Vice President of Government Affairs, athenahealth (Watertown, Mass.).

On defining interoperability, and the wrong way the industry talks about it“In these policy discussions, people use the term ‘interoperability’ interchangeably with information exchange as though they mean the same thing. Information exchange means I send you information and you send me information. You can do that with a fax machine. Interoperability means I can access information that you have, and I can use it, I can change it, I know where it comes from, I know who’s responsible for it. And you can do the same.

“What we have in healthcare is a whole bunch of different healthcare systems that are able to send information back and forth via bidirectional interfaces. That to the Internet is what wire-based telephone systems are to cell phones.”

On the ethics of interoperability“As healthcare professionals, and as an industry, we can no longer accept the status quo. It is possible to have real-time, two-way, low-cost, standards-based connectivity that enables improved decision-making and assures safety at lower cost. The technical capability exists. However, a byproduct of our fragmented national healthcare system is that vendors lack incentives to make their technologies work in a plug-and-play manner.

“We have an ethical obligation to develop and implement plug-and-play clinical devices and information technology systems. Potential improvements from doing so include avoiding or reducing adverse events, transcription errors and redundant testing. Clinicians will benefit from reduced alarm fatigue and time spent manually entering information. Our patients will benefit from decreased length of hospital stays through our ability to improve the speed of information transfers and lower costs related to integrating and maintaining technologies.”

On data standards and challenges in ACOs“You just can’t move quickly enough. UnityPoint Health has a significant presence in the accountable care organization market requiring patient-level communication from both employed and independent providers. The biggest challenge is the lack of interoperability caused by an industry that does not have data standards. We are trying to get data faster so that we can both make it more actionable on the front end, as well as using it for predictive modeling for the population. You can’t mandate that all healthcare organizations utilize the same systems, yet our patients need clinical information to flow from provider to provider. As an industry, we need to work together to regulate data standards.”

Neal Patterson, CEO, Cerner (Kansas City, Mo.).

On healthcare being personal and how interoperability should address that“One thing…we say at Cerner about healthcare, healthcare is too important not to change. Also, healthcare ultimately becomes personal.

My wife [has had] stage 4 cancer since 2007. My version of this [holds up a CD-ROM, indicating it contains health records] with Jeanne are bags and bags. You do go to see doctors that are outside of the organization and you need all that information in those bags. I think it is a failure of all of us to have in 2015 the fact that Jeanne carries bags to her doctors appointments where she’s going to see a new doctor specialists. We have to fix that. Interoperability is high on my list, both professionally and personally, to fix.”

On demanding today’s price for health IT and interoperability“We’re [living] in a world today where an expensive app for your PDA costs you $5, but we have health systems spending hundreds of millions of dollars and taking years to develop closed enterprise systems. As technology got more sophisticated, it’s fallen in price.

“Healthcare needs to start demanding today’s price for IT. Leverage the investments made and unleash information from all of the data being used in patient care, operations and claim production.”

Robert Wachter, MD, Chief of Hospital Medicine, University of California, San Francisco Medical Center.

On healthcare leaders’ idea of interoperability

“Most healthcare leaders don’t stay up at night worrying about [interoperability]. Don’t get me wrong: they care deeply about moving information around; it’s a core rationale for EHRs in the first place. But their definition of ‘around’ is not everywhere. Rather, they want a seamless flow of information around all the buildings they own. They also want interoperability between their system and an outside laboratory they use, their system and Aetna’s claims department, and their system and the local Walgreens.”

On government’s potential to advance interoperability“I think it’s important that policymakers avoid the temptation to micromanage the effort through steps and an overly bureaucratic system. Government needs to pay attention to the ‘what’ of interoperability and the ‘by when’ rather than the ‘how’ and ‘who.’

“We need to not lose sight of the fact that the government is a very significant consumer of healthcare. I think the government has the opportunity in the marketplace as a consumer to push for more patient-centered interoperability.”

On barriers to achieving interoperability“I have two major concerns with current interoperability plans. The biggest concern is that we need to get far more sophisticated in the way that patient-specific information is shared, and it needs to be far more tailored to the specific physician. Secondly, we still do not have the financial models in place. Hospitals are paying for service where the benefits accrue to others, especially to insurance companies. Of course, this also gives better patient care, which is why we are enthusiastic participants, but this is not a good long-term model.”

On why forcing interoperability will inevitably result in failure“Meaningful use requirements dictate we must share data with not only the vendor a health system uses but also a different vendor. ACOs place demand on the need to ingest data from other health systems and physician practices. In addition, the regulatory challenge is always there — legislation that leads to unintended challenges for a provider.

“Several state-designated and local HIEs have failed over the last few years, and I suspect more will fail as they find it difficult to sustain a viable financial model. I anticipate more legislative action at the federal and state level forcing aspects of interoperability.”

On IT’s potential to transform healthcareAdditionally, if you look at this industry, there’s a lot of opportunity for health IT to fundamentally change healthcare. But there may be one stumbling block, and that’s data standards — open data standards and interoperability are key. The industry is still in a place where many big players are protective of their data. While there are great solutions out there, sometimes the solutions can’t get to the data because people keep their systems closed. We see this in other industries, it’s not abnormal. But in healthcare, it’s a serious problem.

Jim Ingram, MD, CMO, Greenway Health (Carrollton, Ga.).

On interoperability across the care continuum“The reality is that it’s like building an interstate system. We did it backward. First, we built all the systems within cities, then we tried to build connections in-between. It would’ve been much easier to build the connections first. As a result, we lost the ability to pull information from other systems.”

On Epic’s interoperability, and defending it“The whole concept of being open and allowing users…to be able to use the exits to do whatever they want was in [the platform] from the very, very start.

“If we don’t speak up, people will believe what others say about us, and an unanswered accusation becomes seen as the truth if you don’t respond. We’re now in a position where we have to [discuss our interoperability efforts].”

John R. Graham, Senior Fellow, The National Center for Policy Analysis (Dallas).

On funding an interoperability ‘unicorn’“Evidence from Congressional investigations suggests that meaningful use bounties have encouraged the adoption of EHRs that are deliberately closed to exchange with other parties. The problem is that exchange data with competitors is fundamentally against the self-interest of the party which created the data.

“The amount of government funding required to overwhelm competitors’ resistance to doing this would surely not be worth it.

“Congress should be very skeptical of appropriating yet more funding to hunt this unicorn.”

On what he would do with IT legislation if given the authority“Stop the electronic medical record vendors from gauging physician offices with cost to connect to other repositories.”

Lisa Khorey, Executive Director, EY Advisory Health Care

On leveraging the patient in interoperability“It remains a challenge to bridge the gap between what providers should do in terms of sharing electronic data and what they actually do. Absent an interoperability program that supports broad data exchange, many clinicians and staff receive patient requests for data without a means to fulfill them. Directing patients to a portal is a fine start, but data trapped in the portal of an EMR is still trapped data.

“Interoperability is defined by data exchange, not data at rest. Patients who desire to direct data to their providers are often served a fax number or asked to print the information so that it can be scanned. Leveraging the patient and his or her data is critical to creating information which drives clinical decision support and results in lower cost and better outcomes. It’s a circle, so plan to iterate.”

To achieve interoperability, much work remains for all healthcare organizations, with many challenges yet to be overcome, according to Lisa Khorey, executive director of EY Advisory Health Care.

A recent American Hospital Association report called interoperability imperative to care improvement, and called for government action to make it happen. However, Khorey hones in on the work facing individual provider organizations in an article at Becker’s Health IT and CIO Review.

Four of the challenges providers must overcome, according to Khorey, include:

Additional costs. Interoperability between systems takes years to achieve, and budgets must reflect iterative investments over a period of years. Dedicated resources and specific skill sets are required, Khorey writes.

Workflow changes. Patient consent and related processes will have to change, she adds. Creating use cases organized around roles and workflow and their specific business objectives is the best place to start.

Complexity. It’s essential to take inventory of the varying vocabularies operating in your organization, she says. Collaborative work groups must be formed to permit data reconciliation and standardization to occur.

Patient engagement. Patients are using their health information more often, asking for electronic copies of their data and offering to electronically submit data to providers. Directing patients to a portal is a fine start, Khorey says, but data trapped in the portal of an electronic medical record is still trapped data.

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